Faustão: Can the rich skip the transplant queue? Understand – 08/29/2023 – Balance and Health

The inclusion of presenter Fausto Silva, Faustão, 73, in the transplant queue was informed by the medical team at the Albert Einstein hospital on the last 20th and he ended up receiving the new heart this Sunday (27th).

The speed with which the transplant was performed surprised many people, who raised rumors that the presenter had jumped the queue because he was famous, which is denied both by authorities and by specialists who follow the list of organ transplants. According to them, this possibility does not exist, since the system itself has locks to avoid favoritism.

According to the Ministry of Health, almost 30% of the transplants performed in Brazil since the beginning of the year occurred with less than a month of waiting after the patient entered the queue, as happened with Faustão.

Read, below, five points about the case.

Why did Faustão have priority in the transplant queue?

The waiting time for a transplant depends on several factors, such as the type of organ, blood type and the condition of the donor and recipient. According to the State Department of Health of São Paulo, for the specific case of Faustão, with blood type B and in need of a heart, the wait was from one to three months. However, as the presenter was in critical condition, he was included among the priority cases, information corroborated by the Ministry of Health, in a note.

After the CNT (Central Nacional de Transplantes) was notified of the donated heart, the computerized management system identified 12 patients who met the requirements to receive the organ. Of these, four had priority due to the seriousness of their health conditions, and Faustão occupied the second position.

The organ was then offered to the transplant team of the patient who occupied the first position, but she refused the organ, a decision that may have been taken due to potential incompatibilities between recipient and donor. In this way, the heart went to the second patient on the list, which was Faustão. In case the team analyzed that the new organ would not be ideal, it would be passed to the third in line, and so on.

Are the rich and famous prioritized?

There is no prioritization of famous and/or upper-class people in the national transplant queue. In it, patients are identified by numbers, not by names, to prevent any kind of personal favoritism.

According to cardiologist Bruno Biselli, supervisor of the Hcor heart failure and transplant program, it is impossible for factors such as financial power and influence to guarantee priority to the recipient.

Another famous person who has already been prioritized in the transplant queue was Mussum, a comedian from “Os Trapalhões”. In 1994, he was hospitalized for five days with severe heart failure until he received the heart. In his case, the transplant was necessary because he had dilated cardiomyopathy, a disease in which the heart increases in size and does not work satisfactorily. The transplant went well and there was no rejection of the new organ. He ended up dying ten days later, but from a serious lung infection.

The funk singer MC Marcinho was not so lucky. He had been hospitalized since the end of June because of heart and kidney failure. However, after being hospitalized, he suffered a cardiac arrest that left him dependent on an artificial heart last month. He remained on the heart transplant queue, but a widespread infection forced him to step out of the queue. As he had diabetes and kidney problems, his more delicate condition made it impossible for him to receive a new organ. Finally, he had been breathing through mechanical ventilation and undergoing hemodialysis, but he died last Saturday (26).

How does the transplant waiting list work?

The list of transplants is unique, controlled by the SUS (Sistema Único de Saúde) and applies to public and private networks. In addition to queue enrollment time, patient severity determines priority. Within the main row is a secondary row, organized by blood type of patients. There are still other criteria to be considered, such as weight, height and an immunological exam that determines if there is a compatibility between donor and recipient.

The age of the donor is relevant. In Brazil, donors over 45 years of age are usually rejected, as there is a greater risk of complications and the lack of complementary tests, such as coronary catheterization in these donors, limits its wide use. In addition, the high number of violent deaths among young people, especially in motorcycle accidents or gunshots, increases the availability of potential young donors.

If there is immunological incompatibility, that is, there is a detection that the recipient has antibodies already formed for the tissue of that donor, it is considered that there is a high chance of hyperacute rejection. In this case, the organ passes to the next one in the queue that is compatible.

How is the process of choosing organ recipients?

Potential donors are identified by the Intra-hospital Transplant Commissions, in Intensive Care Units (ICUs) and Emergencies in patients diagnosed with brain death (death of central nervous system cells). The next step is to seek the authorization of the family for the removal of the organs.

In the process, the hospital needs to notify the State Transplantation Center about the brain-dead patient (potential donor of organs and tissues) or with cardiorespiratory arrest (potential tissue donor) so that the center can confirm the diagnosis and initiate compatibility tests between potential donors and potential recipients on the waiting list. When there is more than one compatible recipient, the decision of who will receive the organ depends on criteria such as waiting time and urgency of the procedure.

Then, through a computerized system, the central generates a list of potential recipients for each organ and communicates the hospitals where they are treated. The transplantation teams, together with the central, adopt the necessary measures to make the removal of the organs feasible (means of transport, surgeons, support staff, etc.), and the transplantation is carried out.

How is the recovery of the transplanted patient?

The postoperative period is similar to any heart surgery in an ICU. The patient is usually extubated within 48 hours after the transplant. Immunosuppressants will be needed for life to prevent the heart from being understood as a tissue that does not belong to the body. These drugs have the role of inhibiting the immune system.

There is a tendency to reduce medication use and there are cases of patients surviving for two decades with minimal doses of immunosuppressive medication. The initial post-transplant phase is the most worrying, especially the first 48 hours and then the first 30 days.

In the first year, the survival rate is 80%. After that, the patient is expected to live for another 12 or 13 years. However, there are cases in which they live much longer than that, such as Francisco Sebastião de Lima, from Alagoas, who lived 34 years after receiving a new heart at the age of 17. He was the longest-lived transplant recipient in the country and died on April 11 of this year.